Individual
STEPHANIE WARYE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MPAS, PA-C
Contact information
Practice address
2228 NW PETTYGROVE ST STE 150, PORTLAND, OR 97210-2761
(032) 885-2015
(503) 288-0151
Mailing address
202 NW 13TH AVE, PORTLAND, OR 97209-2953
(503) 684-8252
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
PA153224
OR
363AM0700X
Medical Physician Assistant
MA054088
PA
363AM0700X
Medical Physician Assistant
Primary
PA153224
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500647021
—
OR
Enumeration date
09/13/2010
Last updated
09/02/2023
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